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NavMed 369 



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UNITED STATES NAVY | 




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Rear Admiral Bartholomew W. Hogan MC USN - Surgeon General 
Captain Leslie B. Marshall MC USN (RET) - Editor 



Vol, 33 



Friday, 20 March 1959 



No. 6 



TABLE OF CONTE NTS 

Antibiotic Therapy >.. Z 

Early Diagnosis of Chronic Simple Glaucoma 8 

Eye Injuria s in Children 10 

Tic Douloureux 13 

Tuberculosis and Carcinoma of the Lvmg 15 

Trichinosis in the United States 17 

From the Note Book 19 

Military Pediatric s Zl 

Aviation Prescription Sunglasses , , 22 

Attention Flight Surgeons ! 22 

Deep Freeze V 23 

Navy Mutual Aid As sociation 24 

Recent Re search Reports . 24 

Requests for Early Release fron:i Active Reserve Duty 26 

DENTAL SECTION 

Navy Dental Care - Calendar Year 1958 27 

Armed Forces and Public Health Section in Journal of Oral Surgery. . . 27 

Malpractice Suits 27 

Board Certification 28 

Newly Standardized Anesthetic 28 

RESERVE SEC TION 

Appropriate Duty Assignments 29 

Course in Functions of the Medical Department 29 

Accreditation for Attending Professional Meetings 30 

OCCUPATIONAL MEDICINE 

Meeting of American Academy of Occupational Medicine 31 

The 1959 Industrial Health Conference 34 

Occupational Dermatitis 35 

Hazards of Noise Exposure 38 



Medical News Letter, Vol. 33, No. 6 



Policy 

The U. S. Navy Medical News Letter is basically an official Medical 
Department publication inviting the attention of officers of the Medical 
Department of the Regular Navy and Naval Reserve to tinfiely up-to-date 
items of official and professional interest relative to medicine, dentistry, 
and allied sciences. The amount of information used is only that necessary 
to inform adequately officers of the Medical Department of the existence 
and source of such information. The items used are neither intended to be, 
nor are they, susceptible to use by any officer as a substitute for any item 
or article in its original fornn. All readers of the News Letter are urged 
to obtain the original of those items of particular interest to the individual. 

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Antibiotic Therapy 

This essay outlines the clinical application of antibiotic agents conn- 
mercially available at present. 

Penicillin 

Penicillin remains the physician's chief weapon against a variety of 
microorganisms, most of which are Gram -positive. Of the many naturally 
occurring penicillins, penicillin G, penicillin O, and penicillin V are the 
fractions which have been produced commercially. 

Aqueous crystalline penicillin G is employed when rapid effect or high 
concentrations of the agent in the serum are desirable. Procaine penicillin G 
is used when a longer acting preparation is called for. In the presence of 
pneumococcic pneumonia, for instance, it is administered intramuscularly 
once or twice daily in amounts of 300, 000 to 1 million units. Benzathine 
penicillin G, in amounts of 600, 000 to 1. 2 million units given intran:iuscularly, 
has been recommended for the long-ternn prophylaxis of rheumatic fever or 
glomerulonephritis in which reinfection by beta-hemolytic streptococci is 
highly undesirable. 

When penicillin is to be employed for a person known to have allergy 
to penicillin G, the hypoallergenic penicillin O has been recommended, but 
the consensus is that use of this particular compound does not assure that 
untoward reactions will not occur. 

The quest for an orally effective preparation of penicillin culminated 
in the discovery and clinical application of phenoxymethyl penicillin, more 
commonly referred to as "penicillin V. " This preparation is readily ab- 
sorbed into the serum when given orally, and concentrations in the blood in 
excess of those that follow similar oral doses of penicillin G are obtained. 

Despite the present availability of many newer antibiotic agents, pen- 
icillin continues to have a wide range of usefulness. Penicillin currently is 



Medical News Letter, Vol. 33, No. 6 



most commonly employed against pneumococcic, gonococcic, streptococcic, 
meningococcic, and syphilitic infections. 

The use of probenecid (Benenriid) nnay increase the content of penicillin 
in the blood, especially if the original content is low, but probenecid may 
also provoke gastrointestinal irritation. 

The indiscriminate use of penicillin often has been decried and hardly 
needs reemphasis. In a recent survey dealing with untoward reactions to 
antibiotic agents, it was found that penicillin was responsible for the greatest 
number. It is worthwhile to mention that, in anticipating such reactions, a 
history of adverse reactions to penicillin in the past or the report that the 
patient previously exhibited other evidence of allergy — particularly asthma — 
is more important than skin testing. 

Streptomycin 

With the exception of the tubercle bacillus, many organisms that are 
sensitive to the action of streptomycin also are sensitive to the tetracyclines. 
These latter drugs do not produce the toxic reactions that may follow the 
use of streptomycin, and organisms usually do not acquire resistance to 
tetracyclines as rapidly as to streptomycin. Therefore, in mild infections 
caused by these organisms, tetracycline often is the drug of choice. How- 
ever, in recent years, it has been concluded by some investigators that 
streptonriycin, when used in combination with other antibiotic agents, may 
produce increased killing of certain organisms; consequently, it is often 
used together with the tetracyclines and other antibiotics. 

Streptomycin-tetracycline therapy is currently held by many to be the 
treatment of choice against brucellosis. Although tularemia is not a common 
disease, it is one of the few in which streptomycin seemingly can be employed 
alone with excellent results. Use of the agent against tuberculosis in com- 
bination with other antituberculous agents hardly requires reiteration. Strep- 
tomycin also is used in combination with the tetracyclines against serious 
infections caused by Gram -negative enteric bacilli. 

Dowling noted that streptomycin may be less likely to cause damage to 
the auditory nerve than will dihydro streptomycin or a connbination of the two 
substances given in equal parts. 

Bacitracin 

Bacitracin is primarily antagonistic to Gram -positive organisms, in- 
cluding most strains of Staphylococcus aureus. It has little activity against 
Gram -negative bacteria except those of the genera Hemophilus and Neisseria. 
An in vitro synergistic effect of this agent in conjunction with penicillin was 
noted by Eagle and Fleishman, and consequently these agents occasionally 
are combined in the treatment of severe infections caused by susceptible 
organisms. Bacitracin also has been given in combination with other agents, 
such as chloramphenicol, with good results against serious staphylococcic 



Medical News Letter, Vol. 33, No. 6 



infections in whicH use of the latter agent alone has not been so effective. 
Bacitracin has been ennployed safely in the form of an aerosol niist in pul- 
monary diseases. The oral administration of bacitracin does not result 
in detectable concentrations in the serum and, consequently, the agent 
thus administered has been found useful against staphylococcic enterocolitis. 

Polymyxin B 

In addition to nephrotoxicity, such manifestations as acroparesthesia, 
cerebellar ataxia, and pain at the site of injection have been observed after 
parenteral use of polymyxin B. Such disturbances may appear within 48 
hours after administration of relatively small doses of the drug, but usually 
they subside within a day or two after administration has been discontinued. 

It is apparent that polymyxin B is to be reserved for those infections 
that do not respond to other agents. The agent is active against Gram- 
negative bacteria of the coliaerogenes group and some strains of Shigella 
and Salmonella, but it is employed naainly against serious infections caused 
by Pseudomonas organisms. 

Neomycin 

Neomycin is active against both Gram -positive and Grann -negative 
bacteria, but when it is given parenterally it is nephrotoxic and may pro- 
duce fever and various symptoms referable to the nervous systenn, includ- 
ing those of damage to the eighth cranial nerve. When administered orally, 
neomycin is not absorbed from the gastrointestinal tract and, thus, it has 
been found useful as an intestinal antiseptic agent. It should be used sys- 
temic ally only when safer antibiotic agents will not suffice. 

During discussion of the preceding antibiotic agents, some untoward 
effects were mentioned. It may be worthwhile to remark that damage to the 
eighth cranial nerve is observed after the adn^inistration of streptomycin, 
dihydrostreptomycin, and neomycin. Such toxicity may also follow the use 
of kanamycin, an antibiotic agent also discussed in this review. 

Tetracycl ine s 

The introduction of tetracycline hydrochloride into clinical medicine 
has largely supplanted use of the older antibiotics, oxytetracycline (Terra- 
mycin) and chlortetracycline (Aureomycin). The compounding of tetra- 
cyclines with such substances as phosphate, citric acid, or glucosamine 
has been said to increase concentrations of the antibiotic agent in the blood, 
but such data are not definitive at this time. 

After the oral administration of the tetracycline compounds, nausea, 
vomiting and, sometimes, looseness of the stools may be encountered. The 
incidence of nausea and vomiting after use of the tetracyclines is reduced if 
the agent in question is given with cold pasteurized milk or with sodium 
bicarbonate or calciunn carbonate in amounts of 5 grains with each 250 mg, 
of the antibiotic agent. 



Medical News Letter, Vol. 33, No. 6 



The tetracyclines are extremely useful against serious Gram-negative 
bacillary infections, such as bacteremia in which they are often used in con- 
junction with a streptomycin preparation. Such a combination of antibiotics 
may have application against postoperative infections caused by Gram- 
negative organisms of enteric origin. The tetracyclines are employed in 
the treatment of other conditions, such as brvcellosis, actinomycosis, 
amebiasis, rickettsial disease, and the less common venereal diseases, 
lymphopathia venereum, granuloma inguinale, and chancroid. The tetra- 
cyclines also are used against mild infections of the urinary tract caused 
by susceptible Gram-negative bacilli of enteric origin, such as coliaerogenes 
and Proteus organisms. 

Chloramphenicol 

Chloramphenicol is an excellent antibiotic agent with a wide range of 
activity against Gram-positive and Gram -negative organisms. It remains 
the agent of choice against typhoid fever. Chloramphenicol also can be em- 
ployed in certain infections caused by Staphylococcus aureus which are resis- 
tant to other antibiotics. The usual oral dose of chloranriphenicol is 500 mg. 
given every 4 hours. Preparations designed for parenteral use are available. 

Because use of this agent has been noted to coincide with depression of 
the bone marrow, chloramphenicol should not be administered indiscrimi- 
nately. 

Erythromycin 

Experiences with erythromycin at the Mayo Clinic have indicated that 
it is effective against many staphylococci, other Gram -positive bacteria, 
and some strains of Hemophilus. However, more than one-fourth of the 
staphylococci encountered in hospitals associated with the Mayo Clinic are 
resistant to erythromycin — a fact that has lessened applicability of the agent 
in this regard. 

Erythromycin is of considerable use in patients who are allergic to 
penicillin and who have infections susceptible to erythromycin. 

Novobiocin 

Because a major probleni in the treatment of infectious disease is the 
management of infections caused by the antibiotic -resistant Staphylococcus 
aureus, the introduction of novobiocin is welcome. Novobiocin is about as 
effective against staphylococci as is erythromycin and displays no cross- 
resistance with older antibiotic agents. It can be given orally and even 
though there seems to be considerable individual variation in absorption, 
adequate quantities of the agent in the serum are obtained. 

Ristocetin 

Ristocetin is a new antibiotic agent which is effective against 
most Gram-positive cocci, but probably is best reserved for serious 



Medical News Letter, Vol, 33, No. 6 



staphylococcic infections which are resistant to the more commonly em- 
ployed antibiotic drugs. The agent can be administered only intravenously. 

Romansky and co-workers have described ristocetin as having pos- 
sible value in the treatment of endocarditis caused by Staphylococcus aureus. 
Streptococcus mitis, and Streptococcus faecalis; additional investigation in 
this regard seems warranted. Ristocetin — like bacitracin and neomycin — 
is not absorbed to any appreciable extent when it is introduced by the oral 
route and, like these agents, it nraay have application in the treatment of 
staphylococcic enterocolitis if the patient's condition allows enteric therapy, 

Triacetyloleandomycin 

Triacetyloleandomycin is a new chemical derivative of the antibiotic, 
oleandomyciuj which has been prepared by the acetylation of three hydroxyl 
groups in the parent molecule. Ths scope of the therapeutic effectiveness 
of triacetyloleandomycin parallels that of erythromycin, and the major in- 
dication for its use is infection caused by some strains of staphylococci 
resistant to other ajitibiotic agents. 

Amphotericin B 

Amphotericin B is a relatively new antibiotic agent that gives evidence 
of usefulness as an effective antifungal drug. There is only minimal absorp- 
tion of amphotericin B after it has been given orally and, therefore, it is- 
usually administered parente rally for systemic infections. The authors have 
found amphotericin B, given for a period of 6 weeks, to be effective against 
cryptococcosis; prelinninary data are encouraging in respect to use of the 
agent against other fungal diseases. 

Kanamycin 

Kanamycin is a new antibiotic agent which must be administered paren- 
terally against systemic infections. Toxic effects of this drug include im- 
paired renal function, dannage to the eighth cranial nerve, acroparesthesia, 
pain on injection, and dermal reactions. 

Although little experience with the agent against clinical infections 
has been accumulated, kanamycin appears to be active against many strains 
of staphylococci, sonrie strains of coliform bacilli, and selected organisms 
of the genera Salmonella and Shigella. The drug appears to be relatively 
inactive against the niajority of strains of streptococci, diplococci, and 
species of Bacteroides, Proteus, and Pseudomonas. In vitro resistance of 
staphylococci and Escherichia coli to the action of kanamycin has been in- 
duced. There is apparently complete cross-resistance between organisms 
able to resist neomycin and the new agent; some evidence suggests partial 
cross-resistance between organisms that can resist streptomycin and the 
new agent. If the latter finding is corroborated, the number of strains of 
staphylococci that are resistant to kanamycin may be higher than was initially 
estimated. 



Medical News Letter, Vol. 33, No. 6 



Staphylococcic Infections 

Recently, much thought and discussion have been devoted to infections 
caused by Staphylococcus aureus, particularly hospital -related infections. 
When a program for the management of staphylococcic infections is planned, 
it should be realized that adherence to principles of asepsis, isolation of 
infected patients, and elimination of carriers of staphylococci are of primary 
importance. Host factors frequently have become altered to such a degree 
as to permit development of such infections. Underlying diseases, such as 
diabetes mellitus, agranulocytosis, hypogammaglobulinemia, leukemia, and 
Gushing 's syndrome, as well as the use of such agents or procedures as 
steroids, nitrogen mustard, roentgen rays, ajitibiotics, and surgery may 
encourage invasion by sta phylococci. Unfortunately, no single antibiotic 
agent will influence favorably all systemic staphylococcic infections and 
reliance must be placed on results of in vitro tests of sensitivity of the organ- 
isms to different drugs and on clinical judgment for the rational management 
of an individual infection. 

Penicillin is the drug of choice against staphylococcic infections if 
the organisms are sensitive to its action. However, many infections caused 
by hospital-acquired staphylococci — for example, those of the so-called 
80/81 bacteriophage types — are insensitive to penicillin so that the adminis- 
tration of penicillin for these infections probably is useless. 

Erythromycin is resorted to if the staphylococci are sensitive to it 
but are resistant to penicillin, or if the patient is allergic to penicillin. 
However, in the presence of certain chronic infections, such as endocar- 
ditis, erythromycin alone will not suffice. 

When infections are caused by erythromycin-resistant strains of 
staphylococci, triacetyloleandomycin may be useful because there is a 70% 
chance that the organisms may be sensitive to its action. The use of tri- 
acetyloleandomycin against strains sensitive to its action, but resistant to 
that of erythromycin, may obviate the need for frequent use of novobiocin. 
This means that novobiocin can be held in reserve. 

Clinical experience with novobiocin in staphylococcic infections has 
been favorable, not only against infections of the skeletal system and soft 
tissues, but also against more serious states, such as bacteremia, pneu- 
monia, and meningitis. However, in the presence of staphylococcic endo- 
carditis, what was said about erythromycin is also true about triacetyl- 
oleandomycin and novobiocin: neither would appear to be the agent of choice, 
used alone. 

If penicillin, erythromycin, triacetyloleandomycin, or novobiocin 
cannot be used in the treatment of systemic staphylococcic infections, re- 
course must be had to agents of less applicability. Because the use of 
chloramphenicol has been associated with the development of blood dyscra- 
sias, it seems best to limit the application of this agent to nonendocardial 
staphylococcic infections in which the infecting strains are sensitive to its 
action, but resistant to the previously discussed antibiotic agents. 



8 Medical News Letter, Vol. 33, No. 6 



Ristocetin and kanamycin have been reported as occasionally causing 
serious side effects and, therefore, these antibiotics probably should be 
reserved for serious staphylococcic infections, such as bacteremia and 
endocarditis against which no less toxic antibiotic will suffice. Ristocetin 
and kanannycin can be administered only parenterally in the treatment of 
systemic infections. 

Bacitracin and neomycin have been used successfully in the treatment 
of various types of staphylococcic infections, but the usefulness of these 
agents has been limited by their toxicity and the need for intramuscular 
administration. 

Streptomycin, because of the rapidity with which staphylococci may 
develop resistance to its action, and polymyxin B which has only slight — 
if any — anti staphylococcic action, usually are not considered in the therapy 
of infections caused by the organisms in question. 

Preliminary experiences in the treatment of serious staphylococcic 
infections with agents thus far limited to investigational use, such as van- 
comycin, have been encouraging. Vancomycin is another potent antibiotic 
that has been very effective in certain antistaphylococcal infections. It hag 
some toxic potentialities. 

It is true that, because of the emergence of strains of staphylococci 
resistant to several antibiotic agents, the practitioner must rely heavily 
on the results of in vitro tests of sensitivity in order to treat such infections 
rationally. Still, time is not always sufficient to allow such investigation. 
When treatment of systemic infections must be started before the results of 
such tests are available, it is recommended that an antibiotic agent be used 
to which the staphylococci in the particular institution or community 
concerned most likely are sensitive. These agents would be novobiocin, 
chloramphenicol, ristocetin, and so on. (Schirger, A. , Martin, W. J. , 
Nichols, D. R. , Antibiotic Therapy - Clinical Application of Available 
Agents: GP, XIX : 102-107, February 1959) 

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Early Diagnosis of Chronic Simple Glaucoma 

Glaucoma designates eye disease characterized by increased intraocular 
pressure. It is of extreme importance because of its relatively high incidence, 
because glaucomatous visual loss is permanent, and because proper early 
therapy prevents visual damage. Adequate supervision of glaucoma requires 
a medical specialist. 

Glaucoma is present in about Z% of persons over 40 years of age — an 
incidence similar to that of diabetes. It is estimated that 800, 000 cases of 
undiscovered glaucoma exist in the United States today and that 12% of the 
nation's blindness is due to glaucoma. 



Medical News Letter, Vol. 33, No. 6 9 



Chronic simple glaucoma is by far the most common type of the dis- 
ease. The condition has aptly been termed "a thief in the night" because 
without warning it gradually and irreversibly destroys vision. It is usually 
painless or, at most, causes slight occasional aching of the eyes. Com- 
plete blindness can occur without any acute attack. The elevated intra- 
ocular pressure causes slow nutritional damage, producing the character- 
istic arcuate scotomata which are unrecognized until they finally encroach 
on central vision. In its advanced states, the disease does not respond 
well to medical or surgical therapy and often progresses to blindness, where- 
as, in the early stages it usually may be controlled with miotic therapy. 

Glaucoma should be suspected under the following circumstances: 

1. If the patient is over 40 years of age. 

2. If there is a family history of serious visual loss (glaucoma is 
hereditary). 

3. If the corneal diameter is 10 mnn. or less (average normal is 
12 mm. ). 

4. If the anterior chamber is shallow and the iris seems to bow 
toward the cornea. 

5. If the frequent unsatisfactory changing of glasses suggests the 
possibility of disease. 

6. K unexplained aching is present about the eyes. 

The coexistence of age over 40 years and any other one of the factors 
listed should strongly suggest the desirability of referral to an ophthal- 
mologist. Tonometric measurement of intraocular tension is required for 
accurate diagnosis. This is done routinely by most ophthalmologists in 
the examination of elderly patients. The intraocular pressure in chronic 
simple glauconna usually is not elevated enough to permit detection by 
finger tension. Finger tension is easily confused with compressibility of 
orbital tissues, and even when done by an expert may be in error by as 
much as 10 mm. of mercury. 

Chronic simple glaucoma is caused by gradually increasing resistance 
to the outflow of aqueous humor due to aging processes in the angle of the 
anterior chamber. The anaton^ic predisposition to glaucoma is genetically 
transnnitted and it is, therefore, most desirable to inquire about familial 
blindness in the routine family history. 

Although certain anatomic features markedly predispose their pos- 
sessors to glaucoma, its occurrence is not inevitable. It must be stressed 
that the great majority of patients with chronic simple glaucoma do not show 
grossly visible changes of any sort. Nevertheless, it is well known that eyes 
with reduced corneal diameters or shallow anterior chambers have a great 
predisposition toward glaucoma. 

Sometimes, it is possible to make a relatively early diagnosis of glau- 
coma through suspicion of vague symptoms. Patients who have had two or 
three pairs of unsatisfactory glasses within a short time may have eye-disease 



10 Medical News Letter, Vol. 33, No. 6 



rather than refractive error. (Psychoneurosis is, unfortunately, another 
cause for such complaints. Many glaucoma patients are tense, nervous 
individuals and may at first be misdiagnosed as having a functional disor- 
der. ) Another group of patients may have vague ocular aching or discom- 
fort, sometimes referred to the occipital region. Glaucoma should be 
considered as a possible cause of such unexplained discomfort in the older 
patient. 

With great frequency, both ocular and systemic diseases manifest 
themselves through visual disturbances and eye fatigue. The patient has 
no way to differentiate these symptoms from those of refractive error. 
Should he seek aid from a nonmedical refractionist, diagnosis of the true 
nature of his difficulty and proper treatment are often considerably delayed. 
In addition, the patient often loses the price of an tmnecessary pair of spec- 
tacles. 

If glaucoma were a disease which could not be modified by treatment, 
early diagnosis would be of little avail. The great majority of early cases 
do respond well to proper use of miotic therapy. By contrast, advanced 
cases often fail to be controlled by medical or surgical means, 
(Havener, W.H. , Early Diagnosis of Chronic Simple Glaucoma: Postgrad. 
Med., 25: 148-151, February 1959) 

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Eye Injuries in Children 

This article discusses the problems involved in eye injuries in chil- 
dren, gives briefly the generally accepted methods of management, and 
emphasizes that the prevention of ocular injury is much more profitable 
than the treatment. 

When compared to all types of injuries sustained by children, eye 
injuries are not common. However, the fact that eye injuries are common- 
er in children than in the general population was shown by a recent study 
which revealed that children up to 9 years of age account for over 20% of 
all serious eye injuries. Because accidents of various kindg cause about 
50% of all blindness in one eye and about 20% of all blindness in both eyes, 
proper and early treatment and prevention of injuries are extremely impor- 
tant. Because of the delicacy and peculiarities of ocular tissues, an injury 
that would be insignificant elsewhere is a serious one in the eye and may 
result in the immediate or eventual total loss of vision in one or both eyes. 

Sharp objects, blows, falls, and foreign bodies produce the greatest 
number of the serious eye injuries (82,2% of all major injuries in one 
analysis). However, BB shot, fireworks, firearms, explosions (dynamite 
caps, St cetera), chemical burns, and thermal burns are also responsible 
for many injuries to the eyes. 



Medical News Letter, Vol. 33, No. 6 11 



Christmas toys are significant as a source of severe eye injuries in 
children. It is surprising how many seemingly harmless toys represent 
the instrument for severe eye injuries. The most obviously dangerous ones 
(BB guns, bows and arrows, and darts) are responsible for the greatest num- 
ber of severe injuries from toys, but sharp-edged metal or plastic toys also 
make a significant contribution, A harmless rubber -tipped bow and arrow 
set becomes a dangerous weapon when sticks and reeds are converted to 
arrows in a friendly game of "cowboys and Indians. '• 

Injuries to the eyes may be the result of (1) toxic chemical agents, 
(2) thermal agents, (3) mechaunical agents, and (4) certain radiations. Of 
the toxic chemicals which are likely to be involved in eye injuries in chil- 
dren, household ammonia, lye, and potassium hydroxide are the most 
damaging agents. 

In contrast to acid burns, which can usually be evaluated immediately, 
alkali burns tend to be progressive and maybe misleading. Evaluation and 
treatment by an ophthalmologist are usually necessary, but should not take 
precedence over the sine qua non of immediate and thorough irrigation. 
A new drug, edathamil (Versene) may diminish corneal opacities in some 
lime burns by removing calcium deposits from the cornea. Prompt and 
prolonged irrigation of all toxic chemicals from the eye should be done 
before medical attention is sought or specific treatment begun. 

Hot liqiiids and flaming clothing or kerosene often injure the eyes when 
the face and upper half of the body are involved in extensive burns, and all 
too frequently, children are the victims of such accidents. Attention to the 
eyes may be of secondary consideration owing to the pressing need for life- 
saving measures. In such instances, Butler has had good results with the 
use of atropine and antibiotic ointment instillations, and if the eyes had to be 
incorporated in an over-all head and face betadage, he did not dress them 
again for as long as a week or 10 days. Severe burns should have the atten- 
tion of an ophthalmologist, but if one is not available at the time of initial 
care, the above method has proven safe and satisfactory. 

Mechanical agents or foreign bodies may injure the lids and globe in 
various ways, causing abrasions, lacerations, contusions, and penetrating 
injuries. The importance of tetanus antitoxin or toxoid shoiHd be remem- 
bered in all injuries of this type. 

Most extraocular foreign bodies may be handled without difficulty. 
They are to be found most frequently under the upper lid and next most fre- 
quently imbedded in the cornea. A moist cotton applicator does not damage 
corneal epithelium as much as a dry one. Any possibility of intraocular 
foreign body should be carefully evaluated and, if one is present or suspected, 
the patient should have the care of a specialist. 

If an abrasion is not seen with focal illumination, it may show up after 
applying to the lower cul-de-sac a fine toothpick cotton applicator of mer- 
bromin (Mercurochrome) or fluorescein. The amount of stain thus released 



12 Medical News Letter, Vol. 33, No. 6 



is small CBOugh to eliminate the need for irrigating excess stain from the 
eye. Lacerations of the lids may reqtiire plastic repair, especially if in- 
volving a lid margin or canaliculus. It should be remembered that plastic 
surgery is more easily done at the time of the initial woim.d before scar 
tissue has replaced and altered normal anatonnical structures, but it 
should be delayed if other injuries make the patient's condition unsuitable 
for prolonged anesthesia. Lacerations of the globe should be examined as 
gently as possible to avoid increasing the damage; both eyes should be 
pjatched with sterile dressings and the patient should be kept on his back 
until surgical repair can be undertaken. 

Contusions produce a variety of eye injuries, such as subconjunctival 
hemorrhages, mydriasis (the pupil maybe permanently dilated), hyphemas, 
iridocyclitis, traumatic cataracts, vitreous hemorrhages, ruptures of the 
sclera or choroid, detached retinas, fractures of the orbital bones, espec- 
ially the orbital rim, and rarely, avulsion of the optic nerve. Most of these 
conditions require special care and may be difficult to recognize without care- 
ful examination. 

Although eye injuries in children caused by radiation are not common, 
from watching a welder at work or from exposure to rays from a quartz- 
vapor sun lamp, they may receive ultra-violet rays s\ifficient to cause dam- 
age. Because the symptoms of severe foreign-body sensation in the eyes 
do not occur for 6 to 10 hours, the patient may not readily recall having 
exposed himself. Repeated instillations of butacalne (Butyn) ointment or 
tetracaine drops may be used to relieve the pain while the corneal epithelium 
heals — usually within 24 hours. The short infra-red rays from electric arcs 
may rarely produce central retinopathy as may also visible rays of the sun. 
This condition is seen most often after an eclipse; the effect is produced by 
a concentration of rays resulting in a thermal burn of the macula, much 
like burning a piece of paper by focusing sunlight with a magnifying glass. 
Tinted glass, glass coated with soot, and photographic film — contrary to 
popular opinion — do not afford adequate protection for eclipse viewers. 
The safest way to observe an eclipse is to allow the sunlight to pass through 
a pinhole in a piece of cardboard and to focus the image on another piece of 
black cardboard, thus producing a clear image of the sun. Before every 
eclipse, the potential hazard to the eyes should be widely publicized, 
(Nelson, J.N. , Eye Injuries in Children: A. M. A, J. Dis. Child., 97: 
105-108, February 1959) 

Use of funds for printing this publication has been approved by the 
Director of the Bureau of the Budget, 19 June 1958. 

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Medical News Letter, Vol. 33, No. 6 13 



Tic Douloureux 

This article reports 25 years' experience in the surgical management 
of tic douloureux based upon 348 patients on whom 391 operations were per- 
formed. The incidence, diagnosis, surgical management, complications, 
and results involved in these cases are discussed. 

The ages of the patients ranged from 26 to 90 years with 80% of them 
over 50 and 43% over 60. The ratio of males to females was 6:7, respec- 
tively. Eighty-three percent had symptoms for more than one year; 40% 
had symptoms for more than 5 years. Definite trigger mechanisms were 
recorded in two-thirds of the patients. Bilateral tic was present in 15. 

Usually, the diagnosis of tic douloureixx is simple— the sudden sharp 
shooting pains involving the second or third division of the trigeminal dis- 
tribution on the face, associated in some cases with trigger zones on the 
face or in the mouth, are well known. Occasionally, there may be some 
difficulty in the diagnosis of the neuralgia involving the first division of the 
trigeminal nerve. In this instance, the pain is less apt to be sudden sharp 
and shooting in character, but does involve the forehead area in the distri- 
bution of the supraorbital and supratrochlear nerves with aching and, in 
some cases, burning; there is no evidence of trigger mechanisms in most 
cases. Experience has been that the supraorbital nerve is frequently hyper- 
sensitive and that its palpation often initiates the pain. 

It should be emphasized that trigeminal neuraliga is not associated 
with neurologic deficits in the distribution of the fifth cranial nerve. When 
such deficits are shown to be present (ainesthesia of the cornea, anesthesia 
or hyperesthesia of portions of the face, or inasseter paralysis), then a 
paratrigemiinal mass — either a tumor or aneurysm — should be suspected. 

The surgical treatment of trigeminal neuralgia has been fairly well 
standardized. Patients experiencing the first attack of the disease are 
usually treated conservatively. There may follow weeks, months, or even 
years of freedom from pain. Others may give a history of an occasional 
pain in the face occurring for a few days every year or two. These patients 
may prefer conservative management also. Still others have repeated attacks 
of pain with the usual typical trigger zones and their condition becomes worse 
in time. They are candidates for surgical management. In a few instances, 
alcohol injection after blocking of the involved division with Xylocaine may 
be profitable. However, injection of alcohol into the various branches of 
the trigeminal nerve is becoming less and less popular with the advent of 
effective surgical management. 

Total or subtotal section of the sensory root by the temporal approach, 
decomipression of the sensory root and ganglion, section of the sensory root 
in the posterior fossa, medullary tractotomy, and avulsion of nerves of the 
face are the n:)ethods used in surgical management. 



14 Medical Ne^ws Letter, Vol, 33, No. 6 



With repeated bouts of pain, decompression may be used with good 
resxilts expected in 75 to 80% of patients. With recurrence of pain, the 
root may be partially or completely sectioned as needed. Among the very 
old patients, section of the sensory root may be a better initial procedure. 
Partial section should be preferred over complete section if section of the 
root is decided upon. If the patient has had alcohol injections with the last 
injection unsuccessful, section of the sensory root is preferred. 

Numbness involving one or two of the divisions of the trigeminal 
nerve may be present following a decompression operation in which the 
operator is fairly sure that no gross damage was done to the fibers of the 
ganglion and the root. A facial paralysis may occur following this proced- 
ure and in some cases may be seen not immediately after the operation 
but 2 to 4 weeks later. Presumably, this may be due to trauma to the 
greater superficial petrosal nerve with traction upon the geniculate gang- 
lion and the facial nerve in the facial canal. 

With recurrence of pain among those with a partial section of the 
root, reoperation may employ either an intradural opening or an extradural 
dissection. Intradural dissection may be somewhat easier if the nerve had 
been partially sectioned extradurally before. 

Peripheral facial paralysis is ordinarily seen soon after the opera- 
tion. Occasionally, it may become manifest 2 to 4 weeks after surgery, 
particularly among those undergoing the decompression procedure. In a 
few instances, the paralysis may last for a week to 10 days. More frequent- 
ly, it lasts for 2 to 6 months. The longer the paralysis lasts the less likely 
is normal return of function. Mass movements of the face and facial spasms 
are common in the group with imperfect return of motor function. When 
facial paralysis is seen after total section, lateral tarsorrhaphy is a good 
procedure to protect the cornea. 

The problem of corneal ulcers is an important one, but in patients 
who have had decompression or partial section of the sensory root, this 
condition becomes much less likely. In the presence of a corneal ulcer, 
in those instances where complete section of the sensory root has been done, 
tarsorrhaphy is an excellent procedure. 

Postoperative paresthesias of the face are common ^mong these 
patients, but only occasionally are they severe or lasting. When they are 
severe, the patients complain bitterly and management is difficult and fre- 
quently unsuccessful. Among those with partial section, paraesthesias are 
less severe and more bearable. Although conservative treatment may be 
used in early cases, in many surgical treatment ultimately becomes neces- 
sary. Decompression of the sensory root was a satisfactory first step in 
83% of patients. Those with recurrence of pain may then be treated by sub- 
total section of the sensory root. Thus, in most patients pain is not exchanged 
for a numb face. (Gurdjian, E. S. , et al. , Experiences in the Surgical 
Management of Tic Douloureux: Surgery, 45: 264-272, February 1959) 



Medical News Letter, Vol, 33, No. 6 15 



Tuberculosis and Carcinoma of the Lting 

The principle of explaining all of the aymptoros and findings of a 
patient as manifestations of the same disease entity is undoubtedly justi- 
fied in the majority of cases. All physicians are familiar with exceptions 
to the rule, particularly in older patients in whom multiple diagnoses are 
not uncommon. The early recognition of two major diseases in the same 
patient presents a real challenge, particularly if both major diseases in- 
volve the same organ. 

Coexistence of pulmonary tuberculosis eind carcinoma of the lung is 
well known. In the cases reported, a common feature is the late diagnosis 
of the neoplasm with a paucity of survivals because the carcinoma is so far 
advanced that successful treatment cannot be applied. Many cases are re- 
cognized only at postmortem examination. 

Famous pathologists have tried to correlate the etiology of the two 
diseases in one way or another and sometimes in exactly opposite ways. 
Today, it is generally accepted that the two diseases are associated only 
coincidentally. It is known that a disease which lowers the general resis- 
tance can activate or aggravate pulmonary tuberculosis. This applies not 
only in carcinoma but in other diseases, such as diabetes, Hodgkin's disease, 
and leukemia. 

Two factors make the problem of coexisting pulmonary tuberculosis and 
bronchogenic carcinoma one with which physicians are confronted increasing- 
ly. First, the distribution of active pvilmonary tuberculosis is moving con- 
stantly toward the older groups. Second, carcinoma of the lung is increasing 
in frequency and constitutes— according to newer statistics — at least 10% of 
all malignant tum^ors; in Rokitansky's time, it was accepted as less than 1%, 
The practical point to remember is that the two diseases coincide more 
frequently now than in the past. Any decrease in deaths or any appreciable 
increase in survival rate has to come by way of earlier diagnosis and treat- 
ment. 

In 6 of 10 cases, the first manifestation of carcinoma was \jm.ilateral 
hilar lymiph node enlargement. This is in accord with the findings of Rigler 
who pointed out that this very important sign is commonly overlooked and 
is usually present before syniptoms appear. The problem is not one of 
diagnosis but of detection. 

Conditions other than carcinoma can produce unilateral adenopathy, 
although these conditions are not frequent in older age groups. Active 
reinfection tuberculosis in adults seldom exhibits radiologically enlarged 
hilum nodes of tuberculous origin. Detection of hilar adenopathy is sig- 
nificant because then other more accurate diagnostic procedures may be 
carried out. Laminagraphy, bronchography, bronchoscopy, and cytology 
tnay be helpful in clarifying the cause of the enlarged hilus. Lymph node 
biopsy should be undertaken if simpler procedures fail to disclose the 



16 Medical News Letter, Vol. 33, No. 6 



diagnosis. Tlie importajit fact is that these studies will not be performed 
unless the hilar adenopathy is detected. A hilus greater than 5.5 cm. in 
transverse diameter is suspicious; above 7.0 cm, should be considered 
abnormal and further evaluated. A difference of more than 2 cm. betwee:^ 
the two hila should also be considered abnormal. 

In some instances where hilar adenopathy is not present, the first 
manifestation of carcinoma may be the appearance of a pulmonary infiltrate 
near to, or remote from, the tuberculous lesions. The presence of such a 
lesion within the normally air -containing lung parenchyma is easy to detect. 
This may persist or increase in spite of the fact that the tuberculous disease 
is improving, cavities are closing, and the sputum of the patient is converted 
to a "negative" status. This should suggest the possibility of a second disease; 
malignancy should be the first consideration. 

Tuberculosis patients often have a useful set of x-ray films. These 
will allow careful comparative study in answering the following specific ques- 
tions: (1) Is the new infiltration associated with ipsilateral hilar adenopathy? 
(2) Is the new infiltration increasing in size in spite of treatment? (3) Does 
it contain calcium of the laminated or the so-called popcorn type, both of 
which are highly unlikely to be associated with malignant lesions? (4) Is 
metastatic bone involvement already present? (5) Has any new cavity 
appeared, particularly peripheral to a hilar or mediastinal mass? (6} Is the 
new lesion located anteriorly? 

The clinical picture of the patient must also be taken into consideration. 
A unilateral wheeze which the patient did not have before is significant and 
should indicate a partial bronchial occlusion. Unexpected hemoptysis or 
blood- streaked sputum require investigation. Weight loss, anemia, and 
other symptoms which occur while the tuberculous process is improving 
radiologically will arouse the alert physician to the possibility of broncho- 
genic carcinoma. (Christoforidis, A. J. , Browning, R, H. , Pulmonary 
Tuberculosis Associated with Carcinoma of the Lung: A, M, A. Arch. Int. 
Med, , 103: 75-82, February 1959) 

****** 

Change of Address 

Please forward requests for change of address for the News Letter to: 
Commanding Officer, U. S. NavEil Medical School, National Naval Medical 
Center, Bethesda 14, Md. , giving full name, rank, corps, and old and new 
addresses. 

****** 



Medical News Letter, Vol. 33, No. 6 17 



Trichinosis in the Uni ted States 

Among all intestinal nematodes, Trichinella spiralis has probably 
made the best adjustment for a parasitic existence. All stages of the life 
cycle are parasitic. The sexually mature worms reside in the small intes- 
tine and produce larvae which invade the musculature and internal organs 
of the host. 

The definitive hosts for this parasite are usually carnivorous man- 
mals, that is, those that eat the flesh and internal organs of infected 
animals. A survey of 2433 mammals representing 42 species in Alaska 
revealed an incidence of infection of 11. 7% in 23 species. Some of the in- 
fected hosts were aquatic m ammals, such as seals and white whales which 
are primarily fish-eaters, indicating that the epidemiology of T. spiralis 
may involve transfer or transient hosts. 

In the United States, trichinosis is a disease of n:ian and the domes- 
ticated pig as well as a syl vatic disease of many wild animal species. A 
survey of trichinosis frona 1953 to 1955 in Iowa emphasised the sylvatic 
nature of this disease. Infected with trichinosis were 14 of 119 rats, 31 
of 308 foxes, 1 of 40 opossums, 2 of 29 raccoons, 12 of 85 mink, and 2 of 
4 coyotes. Examination of 2184 pigs revealed 1 infection and 18 of 1148 
pork products contained trichina larvae. In the Arctic areas, the polar 
bear, dog, and wolf are heavily infected. 

The incidence of trichinosis in the American population is not accur- 
ately known today. It is thought that 25 to 50 million Americans carry 
trichina larvae in their muscles and internal ograns. A majority of these 
infections are symptomless and subclinical. Although most States do not 
make trichinosis a reportable disease, between 200 and 300 cases are re- 
ported each year to the Public Health Service. These are the recognized 
cases. Clinically, trichinosis has all the earmarks of so many other 
diseases that in all probability a large number of cases go undiagnosed. The 
mortality rate for recognized clinical cases was approximately 5% in the 
United States. 

The epidemiology of this disease is well understood. How it is trans- 
mitted to man is known, also how to prevent its spread in the swine popula- 
tion. Serologic diagnosis in the suspected patient is being improved and 
important advances have been made in the treatment of the disease with 
ACTH and cortisone. 

Trichinosis in the United States is perpetuated in a very small pro- 
portion (0. 63%) of the swine population through the feeding of infected scraps 
of pork collected in garbage. It is generally conceded that the prohibition 
of garbage feeding would drastically cut the incidence of trichinosis in the 
domesticated pig, but it wotild probably not eradicate the parasite because 
of the sylvatic incidence of trichinosis in rats and other scavenging species. 



18 Medical News Letter, Vol. 33, No. 6 



Because the collection and use of garbage for swine production, in- 
volving approximately 35% of the connmunities of the United States, prob- 
ably cannot be legislated out of existence, attention has been directed 
toward another meaure, the sterilization of garbage by cooking. Every 
State has some type of law or regulation which prohibits the feeding of raw 
garbage to swine. 

Garbage cooked at 100° C. for 30 minutes is freed of living trichina 
larvae. Approximately 11, 747 (94. 5%) of the 12, 423 premises feeding 
garbage to hogs, report that they are feeding cooked garbage. Because of 
noncompliance by some farmers, the lack of adequate inspection facilities 
by some State agencies, and the expense of cooking garbage, the control of 
trichinosis by this method has not been completely successful. Continued 
education, research, and law enforcement by State and Federal officials 
will do much to strengthen this very effective method of trichina control. 

Inspection of pork products constitutes another means of control. The 
Federal Government requires that "the respective States allow the sale of 
garbage-fed hogs for slaughter only at Federally inspected plant or plant 
having equivalent inspection. " 

The freezing of pork is also advocated for killing trichina larvae in 
infected carcasses. As early as 1914, research by the U.S. Bureau of 
Animal Industry indicated that refrigeration of pork at —15 C. (5 F. ) 
for 20 days is an effective safeguard against trichinosis in man. Quick 
freezing at temperatures of — 37*^ C. ( — 34. 6° F. ) kills trichina larvae in 
2 minutes. In the United States today, meat packing plants do not have the 
space to freeze and store the huge volume of pork processed. The cost to 
the consumer for freezing pork would be approximately 5 cents per pound. 
This economic factor plus consunier resistance to the purchase of pork that 
has been frozen and thawed make this type of control innpractical and dif- 
ficult to initiate. 

Sterilization of carcasses by irradiation has been carefully investi- 
gated by Gould and his co-workers. These workers have estimated that 
facilities using cesium-137 as the source of radiation, costing in excess 
of $500,000 can effectively treat carcasses with 30,000 r9entgens — enough 
radiation to make the larvae incapable of completing their life cycle in the 
host. The cost to the consumer is estimated at 0.23 cents per pound and the 
meat is said to be unaltered, healthful, and palatable. 

The most effective and cheapest control method is the thorough cook- 
ing of pork by consumers. If they were aware of the hazards, many persons 
would not eat uncooked pork or pork products that have been smoked and 
not adequately heated prior to processing. Informing the producer on the 
farm about the dangers of feeding raw garbage to his swine and alerting the 
housewife, food handler, restaurant owner, and others to the dangers of 
eating pork not thoroughly cooked are among the control measures recom- 
mended by previous conferences on trichinosis. But it should be reiterated 



Medical News Letter, Vol. 33, No. 6 19 



that placing the responsibility for control of trichinosis on the consumer is 
not the most efficient method for controlling the disease. 

One aspect of the epidemiology of trichinosis should be emphasized. 
Eradication cannot be accomplished solely by control measures initiated by 
the large farmer or food processor. A number of trichinosis outbreaks 
have been traced to pork products that did not pass through Federally in- 
spected plants. The small farmer with a few pigs which are fed table 
scraps (uncooked garbage) and butchered in local abattoirs account for 
some of the incidence of trichinosis in the United States. 

Ijittle attention has been directed toward the use of long-lasting, broad- 
spectrum chennotherapeutic agents administered in the feed to eliminate 
T. spiralis and other intestinal roundwornis in swine. In mice, medicated 
feed containing 0.15% of cadmiunn oxide produced a strildng reduction in the 
number of adults and larvae harbored by infected animals. 

The use of a skin test for the diagnosis of infection in pigs has not 
received much attention in recent years. Soulsby skin-tested auiimals in 
England and reported cross-reactions with Ascaris infections. With the 
application of newer immunochemical techniques, specific antigens could 
be prepared for this purpose. 

Two flocculation serologic procedures are available for the diagnosis 
of trichinosis. The Helnninthology Unit at the Communicable Disease Center 
uses the bentonite flocculation test for the diagnosis of trichinosis. This 
method has been found to be effective in detecting antibody during acute 
infections in man and animals. 

To be successful, any control program for trichinosis must not con- 
flict with the economics of pork production on the farm or at the process- 
ing plant. The control of trichinosis has benefited more from the measures 
taken to control vesicular exanthema than from all the recommendations 
made for the helminth disease. 

Control will come when the American people are willing to pay the 
price of consuming trichina-free pork. Until that time, the scientific com- 
munity must continue working on more efficient methods of control and on 
instructing the public in methods of protecting its health and well-being. 
(Kagan, I, G,, Ph. D. , Trichinosis in the United States: Pub. Health Rep., 
74: 159-162, February 1959) 

5}: s|e j{! ijc ^ * 

From the N ote Book 

1. CAPT Maurice Schiff MC USN, U. S. N. H. , Oakland, Calif., has been 
notified of his selection as the 1959 recipient of the Harris P. Mosher 
Memorial Award, an honor that comes in connection with his election to 
active Fellowship in The American Laryngological, Rhinological, and Oto- 
logical Society, Inc., "The Triological Society. " (TIO, BuMed) 



ZO Medical News Letter, Vol. 33, No. 6 



2. CAPT C. T. Pridgeon DC USN and LCDR C.S. Scruggs DC USN, on duty 
at the U.S. Naval Support Activity, London, England, presented essays at 
the Annual Clinical Meeting of the American Dental Society of London on 
March 19, 1959, and at the 79th Annual Conference of the British Dental 
Association at Torquay, England, March 25 - 29, 1959. (TIO, BuMed) 

3. A symposium on Medical Operations a^d Research in Climatic and 
Environmental Extrennes was presented to coordinators of the Medical 
Education for National Defense at the U. S. Naval Medical School, NNMC, 
Bethesda, Md. , 4-6 March 1959. (BuMed) 

4. Naval Reserve officers serving on active duty may now submit applica- 
tions for appointment in the Medical Service Corps in the Reserve according 
to BuPersInst. 1120.23A. Appointments are available in the following fields: 
administration and supply; optometry; and in the allied science field which 
includes bacteriology, biochemistry, entomology, physiology, clinical psy- 
chology, experimental psychology, and experimental aviation psychology. 
Women may specialize in dietetics, physical therapy, and occupational 
therapy. Eligibility requirements are listed in the Instruction. (TIO, BuMed) 

5. The incidence of clinical tetanus is sufficiently high to make it obligatory 
that prophylactic measures be taken as part of the emergency treatment of 
any contaminated wound or severe burn. Antibiotic therapy should not be 
relied upon for the prevention of tetanus without proper debridement of the 
contaminated tissue and without passive or active immvinization. (G P, 
February 1959; M. L. Maurer, M. D. , A.M. Fuchs, M. D. ) 

6. The microflora found in normal ears differs significantly fromi the micro- 
flora found in the ears of patients with otitis externa and otitis media. A 
combination of polymyxin B, neomycin, and bacitracin is recommended in 
the treatment of external otitis and chronic otitis media. Furacin is very 
effective against infections due to gram -positive cocci. (Postgrad. Med. , 
February 1959; W.M. Saunders, T. Suie, S. A. Sroufe) 

7. The clinical observations and experiences of management of 143 patients 
with primary interstitial cystitis are discussed. Early diagnosis and con- 
servative treatment are advocated. All lesions of interstitial cystitis 
should have a biopsy for tissue study. (J. Urol., January 1959; W.J, Baker, 
D. H. Callahan, Jr. ) 

8. In this investigation the authors have attempted to evaluate perphena- 
zine, a new amino derivative of chlorophenothiazine for its effectiveness 
in reducing the amount of narcotic required for satisfactory analgesia and 



Medical News Letter, Vol. 33, No. 6 21 



anesthesia, reducing fetal narcosis; and producing the desired tranquilizing 
and antiemetic response. (Am. J, Obst. & Gynec. , February 1959; T. G. 
G ready, Jr., M. D. et al. ) 

9. The onset, age incidence, clinical findings, and course of fifty-one con- 
secutive cases of multiple myeloma are reviewed. There were 18 cases with 
myelomatous kidneys. Ten percent of the patients had findings of paraplegia. 
Two cases with "rheumatic arthritis" had amyloidosis complicating myeloma. 
(A.M. A, Arch. Int. Med., February 1959; H. Glenchur, M. D. et al. ) 

10. A survey of 80 cases of deep venous thrombosis indicates a serious fail- 
ure rate in the form either of recurrent venous thrombosis or of originally 
occurrent or recurrent pulmonary embolism treated by anticoagulants. 
Heparin seemed more effective than Dicumarol in relieving the symptoms of 
venous thrombosis. Venous ligation, especially at the level of the vena cava, 
when tolerable by the patient and when supplemented by postoperative anti- 
coagulant therapy seemed to offer the safest course with minimal morbidity. 
(Surgery, February 1959; W. F. Barker, M. D. ) 

11. The clinical, hematological, and pathological characteristics in Aldrich's 
syndrome (thrombocytopenia, eczema, and infection) are reviewed and 7 new 
cases presented. All patients were boys. The syndrome appears to be trans- 
mitted as a sex-linked recessive trait. (A. M, A. J. Dis. Child., February 
1959; W. Krivit, M.D., R. A. Good, M. D. ) 

12. Results of an investigation to provide information applicable to the pre- 
vention of rabies in foxes are summarized and interpreted from the public 
health point of view. (Pub. Health Rep., February 1959; D. E. Davis, Ph.D., 
J. E. Wood, Ph. D. ) 

>!e 9)c sjc :^ ^ ^e 

Military Pediatrics 

A Standing Committee on Military Pediatrics was recently established 
by the Executive Board of the American Academy of Pediatrics. This tri- 
service committee, composed of MAJOR B.H. Berrey (MC) USA, Chairmanj 
CAPT W.I. NeiMrk MC USN: CDR F.B. Becker MC USN; and MAJOR 
T. M. Holcomb (MC) USAF has received the support of the Surgeons General 
of the Army, Navy, and Air Force. 

The scope of the committee's activities will include fostering high stan- 
dards of Pediatric training through liaison with the respective Surgeons 
General and the Academy of Pediatrics, stimulating study and research into 
the practice of Pediatrics, especially in the Uniformed Services, euid studying 



22 Medical News Letter, Vol. 33, No. 6 



the problem of management of mass casualties as it relates to the Pediatric 
population of the United States. 

Meetings of this committee will be held during the Annual Meeting of 
the Academy of Pediatrics and all Medical officers specializing or interested 
in Pediatrics are encouraged to attend. (ProfDiv, BuMed) 

****** 
Aviation Prescription Sunglasses 

Requests for prescription sunglasses are being received in accordance 
with BuMed Instruction 6810.4 of 18 Jiine 1958, and the item in the BuMed 
News Letter of 19 December 1958. A review of the status of the funds for 
the procurement of this item has revealed that sufficient funds remain in 
the Fiscal Year 1959 budget to provide prescription sunglasses for Naval 
aviators and for a number of aircrewmen and other flight deck personnel. 
Requests previously denied for aircrewmen should be resubmitted. 

Attention is invited to the availability of occupational bifocal sunglasses 
which have a second segment at the top of the lenses of particular value to 
presbyopic aviators for viewing overhead instruments and radio controls. 
All requests should be forwarded promptly to the Ophthalmic Lens Labora- 
tory, U.S. Naval Supply Center (Norfolk), Cheatham Annex, Williamsburg, 
Va. , in accordance with paragraph 6. of BuMed Instruction 6810. 4. 

(AvMedDiv, BuMed) 

****** 
ATTENTION FLIGHT SURGEONS ! 

PROCUREMENT OF OPNAV FORMS 3750-8, -8A, -8B, -8C, -8D, -8E, 
(Medical Officer's Report of Aircraft Accident, Incident, or Ground Accident, 
pages 1 through 6) 

A recent tabulation showed that Navy and Marine units had placed 
orders for 16, 740 page sets of Form 3750-8. With normal Usage, such a 
supply would suffice for a period of 10-15 years; while paragraph 57(e) 
page 34, of OpNav Instruction 3750. 6C clearly states "quantities requested 
are not to exceed a six months' requirement. " 

In addition, instances have been reported wherein NavAer 140 has not 
been used in ordering these forms and in other instances the order has not 
been sent to the proper supply point. 

In view of this situation, the following details should be clearly under- 
stood: 

1. A great deal of effort and expense was involved in making the pre- 
paration of this form by the user as easy and straightforward as possible. 



Medical News Letter, Vol. 33, No. 6 23 



2. The forms should not be stockpiled (beyond normal requirements) 
where adverse conditions may deteriorate the interleaved carbon paper. 

3. The Naval Aviation Safety Center cannot process its accident data 
without receipt of this new form. 

4. Use of the old form 3750-8 (Rev. 2-54) obstructs the Safety Center's 
painstaking coding of accident data. 

5. A fresh supply of the new forms is now available from the follow- 
ing supply points: NAS North Island, NAS Alameda, NAS Norfolk, NAS 
Jacksonville, and NSD Guam. 

6. Paragraph 57(e), page 34, of OpNav Instruction 3750. 6C contains 
explicit instructions on the procedure for ordering these forms. 

7. A careful reading of the entire section H (pp 33-50) of the above 
Instruction is not only essential to the proper preparation of the forms, 
but also will reveal many time-saving aspects. 

THE FOLLOWING ACTION IS REQUIRED OF ALL FLIGHT SURGEONS : 

1. CONSIDER ALL PREVIOUS ORDERS FOR THE FORM CANCELLED. 

2. REORDER A REALISTIC QUANTITY BASED ON AN ANTICIPATED SIX 
MONTHS REQUIREMENT. 

3. RETURN AT ONCE EXCESS SUPPLIES OF THE FORMS PRESENTLY 
ON HAND TO THE NEAREST SUPPLY POINT. 

(AVMEDDIV, BUMED} 

3(c ^ if: >!<: ^ ^ 

DEEP FREEZE V 
1959 - 1961 

General Medical officers and Flight Surgeons are needed for Operation 
DEEP FREEZE V which supports the U. S. Antarctic Research Program, a 
continuation of the International Geophysical Year in the Antarctic. 

This is an opportunity for adventuresome volunteers under 45 years of 
age to get into a new and growing field of military medicine. Doctors 
selected will report to Construction Battalion Center, Davisville, R, I. in 
the spring or early summer of 1959 for several months of special training 
prior to embarking for New Zealand and Antarctica in the fall of 1959. They 
will return to CONUS in the early spring of 1961. All possible consideration 
will be given to preference for duty assignment upon completion of a tour of 
duty in Antarctica. Reserves, Regulars, and the graduating class of interns 
will be considered. Volunteers notify BuMed by dispatch. (ProfDiv, BuMed) 



24 Medical News Letter, Vol. 33, No. 6 



Navy Mutual Aid Association 

The Board of Directors of the Navy Mutual Aid Association, February 
26» 1959, announced the election of ADM Arleigh Burke USN as President. 
Other officers elected by the membership were RADM A. H. Van Keuren, USN 
(Ret), First Vice President, VADM Frank Baldwin SC USN (Ret), Second 
Vice President, LTGENR.E. Hogaboom USMC, Third Vice President, 
RADM K. K. Cowart USCG, Fourth Vice President, and CAPT R. R. Rambo 
MC USN, Vice President-Medical Director. 

CAPT T. S. Dukeshire SC USN (Ret) was reelected as Secretary and 
Treasurer and LCDR T. L. Jackson MSC USN (Ret) as Assistant Secretary 
and Treasurer. All officers and directors serve without compensation with 
the exception of the full-time Secretary and Treasurer and his assistant. 

ADM Burke remarked that the Navy Mutual Aid Association exists 
specifically for the purpose of rendering immediate and practical help to 
the families of officer personnel. Navy Mutual Aid has for more than 80 
years provided the answer to this continuing problem. 

CAPT Dukeshire reported that membership in the Association had 
passed the 25, 000 mark. Assets increased by nearly $4, 000, 000 to a total 
of Thirty-Nine and One -Half Million Dollars. The net investment increase 
on the Association's high grade bond portfolio increased from 3, 32% in 1957 
to 3. 58% in 1958. Operating expenses decreased from 3-1/2% of the total 
income to 2-1/2%, During the sanne period, the Association had the npost 
favorable mortality experience since 1888, the death rate from all causes 
including aviation being 6. 29 per 1000 as compared with 8. 11 in the prev- 
ious year. (NavMutAid) 

****** 
Recent Research Reports 

Naval Dental Research Facility, NTC, Bainbridge, Md . 

1. Survey of Dental Health. VI. Relation of Place of Birth, NM 75 01 26. 04, 
30 September 1958. 

2. Survey of Dental Health. VII. Relationship of the Score on the General 
Classification. NM 75 01 26.04, 15 October 1958. 

3. Survey of Dental Health of the Naval Recrxut. VIH, Relation of Formal 
Education. NM 75 01 26.04, 15 October 1958. 

4. Survey of Dental Health. XII, Relation of Brothers and Sisters. 
NM 75 01 26 .04, 30 November 1958. 

Naval Medical Research Institute, NNMC, Bethesda, Md. 

1, Coronary Arteriography. New Electronically Controlled Method. 

NM 71 03 00. 01. 02, 31 October 1958. 



Medical News Letter, Vol. 33, No. 6 25 



Naval Medical Research Uni t No. 3, Cairo, Egypt 

1. Microbiologic Study of Liver Biopsies in Chronic Fibrocaseoua Pulmonary 

Tuberculosis Cases in Egypt. NM 72 01 03. 12.01, July 1958. 

Naval Air Development Ce nter, Johnsville, Pa. 

1. An Elastic Reservoir Theory of the Human Systemic Arterial System Using 

Current Data on Aortic Elasticity. Report No. 7, NM 11 01 12. 6, 7 November 

1958. 

Naval Medical Research Laboratory, S ubmarine Base, New London, Conn. 

1. Measurement of Dextrose in Standard Solutions with Dreywood's Anthrone 
Reagent and the Klett-Summerson Photoelectric Colorimeter. Report No. 294, 
NM 24 01 20.02.01, 10 April 1958. 

2. Effects of Carbon Dioxide as Related to Submarine and Diving Physiology. 
Memorandum Report 58-11, NM 24 01 20.01.02, 20 August 1958. 

3. Photometric Survey of the Red Lighting Installation on the USS Swordfish 
{SSN-579). Memorandum Report 58-12, NM 22 02 20.01.03, 17 October 1958. 

4. Report on a Direct-Current High-Pressure Xenon Arc. Memorandum 
Report 58-8, NM 22 01 20.01,03, 6 November 1958. 

5. Photometric Survey of the Red Lighting Installation on USS Growler 
(SSG-577). Memorandum Report 58-13, NM 22 02 20.01.04, 9 December 1958, 

Naval School of Aviation Medicine, NAS, Pensacola, Fla. 

1. Evaluation of Certain Visual and Related Tests. V. Retinal Rivalry. 
Subtask No. 6, Report No. 5, NM 14 01 11, 11 August 1958. 

2. Study of the Variables from the Bureau of Naval Personnel's Aviation 
Score Sheet. Subtask No. 15, Report No. 1, NM 16 01 11, 1 September 1958. 

3. Non-Auditory Effects of High Intensity Sound Stimulation on Deaf Human 
Subjects. Subtask 2, Report No. 5, NM 13 01 99, 8 September 1958. 

4. Non-Medical Correlates of Medical Complaints. Subtask No. 4, Report 
No. 6, NM 16 01 11, 15 September 1958. 

Naval Air Material Center, Philadelphia, Pa . 

1. Frequency Spectrum and Tissue Noise in Surface Electromyography, 

Preliminary Report. NM 17 01 13 1, 17 November 1958. 

Naval Medical Research Unit No. 2, Taipei, Taiwan 

1. Second Asian Influenza Epidemics Occurring in Vaccinated Men Aboard 
U.S. Navy Vessels. NM 52 05 02.4.2, 6 January 1959, 

2. Pharyngoconjunctival Fever in Taiwan. Report of Four Cases Caused 
by Adenovirus Type 3. NM 52 05 02. 1. 0. 1, 20 January 1959 

****** 



26 Medical News Letter, Vol. 33, No. 6 



Requests for Early Release from Active Duty 
by Reserve Medical Officers 

During recent weeks, the Bureau of Naval Personnel has received 
many requests from Reserve Medical officers for early release. Because 
many of these officers are scheduled to begin residency training about 1 July 
1959» their desire for early release is understandable. However, the Bureau 
of Medicine and Surgery and the Bureau of Naval Personnel have had to dis- 
approve the requests with great regret for the following reasons; 

1. The costs incident to an officer's separation, such as his travel, 
his dependents' travel, and the lump sum payment of his accrued leave, 
become a very sizable sum when considering the number of officers con- 
cerned. If an officer completes his separation processing on 1 July or 
later, these costs are charged to Fiscal Year I960 funds, but if he com- 
pletes separation processing prior to 30 June, the costs must be paid from 
Fiscal Year 1959 funds. Unfortunately, funds remaining in Fiscal Year 
1959 budget are not sufficient to defray the costs involved in the early re- 
lease of officers scheduled for release in Fiscal Year I960. 

2. Approximately 400 Reserve Medical officers are scheduled for 
release from active duty in July 1959, and reliefs will not be available 
until the latter part of July or early August. Even with those to be re- 
leased remaining until the scheduled release date, the hiatus between 
departees and replacements will produce a great hardship on personnel 
in many activities already overburdened by heavy workloads. 

In spite of the fact that the Navy would like to grant the requests of 
those who have served in a highly satisfactory manner, the factors dis- 
cussed above preclude such action. Realizing the importance of residency 
training, every effort is being made to assist officers wherever budgetary 
limitations permit. Each officer's release orders will be issued as soon 
as possible to enable him to use annual leave if authorized by the Command- 
ing Officer prior to separation, to complete the settlement of his dependents 
and household effects. He cannot, of course, be reimbursed for his depen- 
dents' travel until separation. In addition, orders will be written with max- 
imum permissible flexibility so that the Commanding Officers may, if local 
workload permits, approve the earliest possible date of release. 

(ProfDiv, BuMed) 
****** 

Correction . In News Letter, Vol. 33, No. 5, dated 6 March 1959» page 15, 
para. 2, line 2 of article Acute Cholocystitis should read: "Eighty-two 
patients (62%) were women, twice as many as men, " and not "were men. " 



Medical News Letter, Vol. 33, No. 6 



27 



DEI\[TilL 




SECTIOI^ 



Navy Dental Car e - Calendar Year 1958 

During calendar year 1958, some 7,475,000 dental procedures were 
performed in Navy Dental facilities. A breakdown of procedures reveals 
approximately 3, 079, 000 operative and crown and bridge procedures, 
83,000 prosthodontic procedures, 394, ZOO oral surgery procedures, and 
575,300 periodontic procedures. Approximately 1,702,000 radiographs 
were taken and 1,641,500 dental examinations and postoperative treatments 
were given. 

Of the total number of dental procedures rendered, 6,890,000 were 
performed for Navy and Marine Corps personnel, 74, 000 for U. S. Army and 
U.S. Air Force personnel, and 373,000 for military dependents. Approxi- 
mately 285,000 procedures were performed for dependents overseas. 

^ :}: ^ ^ ;{c >!c 

Armed Forces and Public Health Section 



in Journal of Oral Surgery 

The Editorial Board of the Journal of Oral Surgery, Oral Medicine and 
Oral Pathology has instituted a section devoted to the Armed Forces and 
Public Health Service in its publication. Rear Admiral Curtiss W. Schantz, 
Chief, Dental Division, Bureau of Medicine and Surgery, has been appointed 
as an advisor, and Captain Theodore A. Lesney DC USN, Chief of Dental 
Service, U. S. Naval Hospital, San Diego, Calif. , has been appointed as 
Associate Editor. Captain Robert A. Colby DC USN, U. S, Naval Dental 
Clinic, Yokosuka, Japan, is Editorial Consultant for Oral Pathology. 

9jc ^ >J; i{c ^ ^ 

Malpractice Suits 



The question of tnalpractice suits against Navy Dental officers arises 
periodically. The subject is covered in the Manual of the Medical Depart- 
ment, Articles 3-29 and 6-36. Some salient facts not covered in the Manual 
are : 



28 Medical News Lietter, Vol. 33, No. 6 



1. A Dental officer may be sued alone or in conjunction with the 
Federal Government. 

2. Malpractice s\iits against an officer may include his commanding 
officer (U. S, Naval Dental Clinics), senior Dental officer, or chief of 
Dental service even though they have no part in the treatment. 

3. The Federal Tort Claims Act does not constitute a protective um- 
brella for the Navy Dental officer. 

4. The Federal Government does not , of necessity, have to provide 
counsel. 

The purchase of malpractice insurance is a matter of personal concern 
to the individual Dental officer. The Armed Forces Medical Journal of 
February 1958, page 224, contains an excellent discussion of this subject. 

:{! :^ ?!: ^ ^ ;{c 

Board Certification 

Captain Louis S. Hansen DC USN was certified recently by the American 
Board of Oral Pathology. Captain Hansen who is the third Dental officer of the 
Navy to be so certified is on the staff of the U. S. Naval Dental School, National 
Naval Medical Center, Bethesda, Md, 

* * :^ * * * 

Newly Standardized An esthetic 

A newly standardized dental anesthetic is now available for issue and 
will supplement FSN 6505-261-7240, Lidocaine Hydrochloride with Epine- 
phrine Injection, Cartridges, 2%, 1.8 cc, BOs:, presently classified as 
Standard type. New item and description is: 

Stock No . Item Description Unit Fraction Unit 

Issue Code Price 

6505-576-8842 Lidocaine Hydrochloride with Can F $2.90 

Epinephrine Injection, Car- 
tridges, 2%, 1.8 cc, 50s:NNR 
quality. Each cc. contains 20 
mg. of lidocaine hydrochloride 
and 0. 01 mg. (1: 100,000) of 
epinephrine. For use with car- 
tridge syringe, 6515-559-3000. 



Medical News Letterj Vol. 33, No. 6 29 




RESERVE SECTION 



Appropriate Duty Assignments 

Naval Reservists who are members of drilling imits may now be issued 
appropriate duty orders to accomplish certain tasks in support of the Naval 
Reserve and Naval Service generally. 

1. Medical and Dental officers may be issued appropriate duty without 
pay orders as consultants at Naval hospitals. (Detailed information con- 
cerning assignment as a consultant is contained in BuMed Instruction 
101. lA of 26 June 1958). 

2. Naval Reservists maybe assigned appropriate duty orders with- 
out pay for representing their commandant in local areas where he can- 
not be represented by suitable active duty personnel. Such representation 
includes attendance at public ceremonies and other matters concerned 
with legal duties, public relations, the adnninist ration of the Naval 
Reserve in a local community, and recruiting personnel for membersliip 
in drilling units. (This includes recruiting of medical students and clin- 
ical psychologists at colleges and universities). 

3. Attendance at symposia or other training or lecture progran:is 
conducted under the auspices of the Armed Forces; (Symposia must be 
sponsored by, and under control of, the nnilitary and nnay be conducted 
in conjunction with professional conventions. In this event, they must 
have received prior approval of the Bureau of Medicine and Surgery and 
the Chief of Naval Personnel). 

These inmportant changes have been authorized by the Chief of Naval 
Personnel in BuPers Notice 5400, dated 6 February 1959, which promul- 
gates Ch. 2 to BuPers Instruction 5400. IG (Subj: Tables of Organization 
for the Naval Reserve, Fiscal Year 1959). 

:{::{: :Ji :js ^ >ii 

Course in Functions of the Medical Department 

This Course (NavPers 10708-2, 1959 Edition) is based on Part 1 of the 
Manual of the Medical Department. It is designed to provide MD personnel with 
fxindamental knowledge of the significant functions of the Medical Department 



30 Medical News Letter, Vol. 33, No. 6 



in its relation to the Naval Establishment ashore or afloat in all of its 
activities. In addition to the delineation of authoritative methods and pro- 
cedures, the material embraces discussions of approved essential organ- 
izational structure of all types of MD components; these range from the 
Bureau of Medicine and Surgery through various field agencies in all areas 
of activities, in the regional and district medical staffs, to MD organiza- 
tion in ships and on shore stations. 

Because the Medical Department is guided in matters of administra- 
tion by Navy Regulations, current directives of the Bureau of Medicine and 
Surgery and the Manual of the Medical Department, certain chapters of the 
Manual have been selected as the principal text for the course. The text 
constitutes chapters 1 through 14, 17, 18, 20, 21, and 22. It incorporates 
page changes 1 through 6 and is a minor revision of the previous course. 
SecNav Instructions 6320. 8 and 6320. 9 relating to the Medical Service — 
Dependents' Medical Care and Comptroller Fiscal Policies— Dependents 
Medical Care and BuPers Instruction 1750. 5A as reflected in BuPers Notice 
1750 of 8 May 1957, are furnished as supplementary reading material, but 
no questions are based upon this material 

The course consists of nine (9) objective type assignments and is 
evaluated at twenty-four (24) Naval Reserve promotion and/or nondisability 
retirement points. Naval Reserve personnel who previously completed 
course NavPers 10708-1 will not receive additional credit for completing 
the revised course, NavPers 10708-2. 

Applications for this course should be submitted via applicant's com- 
mand, to the Commanding Officer, U. S. Naval Medical School, National 
Naval Medical Center, Bethesda 14, Md. (Attn: Correspondence Training 
Division). 

Medical personnel may be enrolled in more than one Medical Depart- 
ment correspondence course at one time. 

sic jjc ;3c ^ :^ ^ 

Accreditation for Attending Professi onal Meetings 

Frequently, the Chief, Bureau of Medicine and Surgery receives letter 
requests from organizations and societies of the medical profession request- 
ing that their annual meeting or convention be approved for the awarding of 
Reserve retirement points to eligible inactive Reserve MD personnel who 
might attend. In some instances, the requests cannot be approved as certain 
requirements set forth in Department of Defense Instruction 1215. 7 and 
Department of the Navy policy have not been connplied with. 

Because many Reserve Medical Department officers are members and 
executives in these societies and organizations, the publication of the require- 
ments prerequisite to authorizing retirement point credits should serve in the 
best interests of all concerned. 



Medical News Letter, Vol. 33^ No. 6 31 



The requirements are; 

1. Symposia, conventions, meetings, and seminars presented by 
professional medical and allied science societies must designate a 
period or periods identified as a military section. The military section 
presentation must be of at least 2 hours or more in duration each day 
in order to earn one retirement point credit, 

2. The military section must present subjects of a medical nnilitary 
nature which could reasonably be expected to improve the individual 
Reservist's fitness to perform military duty to which he might be 
assigned in the event of mobilization. 

3. The lecturers, moderators, or panel members should in the 
majority be of the military services either active or inactive. This in 

no way precludes the occasional utilization of civilian lecturers or instruc- 
tors. 

4. The planned program must be submitted in advance with a letter 
to the Chief, Bureau of Medicine and Surgery, who will appropriately 
endorse such request and forward it to the Chief of Naval Personnel, 

The Chief of Naval Personnel will evaluate the request and if he approves, 
he will authorize retirement point credits to be awarded eligible inactive 
Naval Reservists who attend and record their attendance. 

Following approval by the Chief of Naval Personnel, the Chief, Bureau 
of Medicine and Surgery will appropriately inform the requesting organiza- 
tion or society and timely publicity will be provided through the various 
Navy Department and Bureau publications. 

Seminars, conventions, and annual meetings approved for Reserve 
accreditation earn only retirement point credit. Reserve promotion points 
must be earned through other approved methods. 

****** 

OCCUPATIONAL MEDICINE 

Meeting of American Acad emy 
of Occupational Medi cine 

The 11th annual meeting of the American Academy of Occupational 
Medicine was held in the Sheraton- Plaza Hotel, Boston, Mass., February 
11-13, 1959. Captain Lloyd B. Shone MC USN attended as representative 
of the Bureau of Medicine and Surgery. 

The meeting was formally opened at 9 :1 5 a. m. with Doctor Ronald F. Buchan 
President of the Academy of Occupational Medicine, presiding. Upon conclusion 
ofhis introductory remarks, Dr. Buchan introduced Doctor Charles C, Lund, 
President of the Massachusetts Medical Society. Dr. Lundwelcomed members 



32 Medical News Letter, Vol. 33, No. 6 



of the Academy to Boston and extended best wishes in behalf of himself 
and the other members of the Massachusetts State Medical Society for a 
frviitful meeting and a pleasant visit to Boston. 

The following is a resume of the professional program presented 
during the Academy's 1 Ith annual meeting: 

Pharmacological and Biochemical Approaches to Mental Disorders 

1. Physiological Basis for Consciousness 

Elwood Henneman, M. D. , Assistant Professor of Physiology, 
Harvard Medical School 

2. Biochemical Aspects of Schizophrenia 

Mark Altschule, M, D. , Assistant Professor of Medicine, 
Harvard Medical School 

Health Information for Employees 

Richard J. Sexton, M. D. , Charleston, W. Va. 

Massachusetts Institute of Technology - Field Trip 

Harriet L, Hardy, M. D. , Assistant Medical Director 
in Charge of Occupational Medical Services 

George F. Wilkins, M. D. , Boston, Mass., presided over the following: 

Transplantation of Normal Human Tissue - Present Status and Future 
Moderator - John P. Merrill, M. D. , Assistant Professor 
of Medicine, Harvard Medical School, Senior 
Associate in Medicine, Peter Bent Brighann 
Hospital 
Participants -Joseph E. Murray, M. D. , Director of Surgical 
Research Laboratory, Harvard Medical School 
Gustav Dammin, M. D. , Professor of Pathology, 
Harvard Medical School 

John R. Brooks, M. D., Clinical Associate in 
Surgery, Harvard Medical School 
Somers H. Sturgis, M. D. , Clinical Professor 
of Gynecology, Harvard Medical School 

Immunologic Basis for Rejection of the Homograft 
Doctors Merrill and Dammin 

Clinical Experience with Homografts and Isog rafts 

Poctors Murray, Sturgis, and Dammin 



Medical News Letter, Vol. 33, No. 6 33 



Approaches to the Homograft Problem 

Doctors Merrill, Murray, and Brooks 

Recent Advances in the Therapy of Infectious Diseases 

Louis Weinstein, M. D. , Professor of Medicine, Tufts Ujoiversity 

School of Medicine 

Leonard J. Goldwater, M. D. , Professor of Occupational Medicine, 
Columbia University, presided over the following: 

Fatalities from the Use of EDTA in Lead IntoxicatioT? 
Heinrich Brugsh, M. D. , Division of Occupational Hyg' one. 
Commonwealth of Massachusetts 

Recent Investigations on Atmospheric Pollution 

Mary O. Amdur, Ph, D. , Assistant Professor of Physiology, 

Harvard School of Public Health 

Physiological Aspects of Human Fatigue 

William S. Frederik, M. D. , Lecturer on Physiology, 

Harvard School of Public Health 

Harriet L. Hardy, M. D. , presided over the following: 

Ocular Effects of Radiation 

David G, Cogan, M. D. , Professor of Ophthalmology, 

Harvard Medical School 

Symposium on the Nuclear Reactor and Its Products 

1. Fundamentals of a Nuclear Reactor 
' Theodore J. Thompson, M. D. , Professor, Department 

of Nuclear Engineering, Massachusetts Institute of 
Technology 

Z. Health Hazards Associated with a Nuclear Reactor 

Constantine Maletskos, Ph, D. , Radiation Biologist, 
Massachusetts Institute of Technology 

3. Chemical Applications of Reactor Products 

Martin Lubin, M. D., Ph. D. , Professor of Pharma- 
cology, Harvard Medical School 



34 Medical News Letter, Vol. 33, No. 6 



The Academy's annual banquet was held at 7:00 p. m. on February 12. 
It is the custom during the banquet to present an Academy award in the form 
of a plaque to a physician whose work in the field of occupational medicine has 
been outstanding. This year, the award was given to James H. Sterner, M. D. 
Also during the banquet, some person who has distinguished himself in the 
field of occupational health is called upon to deliver the George Gehrmann 
JLecture. This year's Lecture was given by Professor Philip Drinker of the 
Harvard School of Public Health. 

An election of officers for the ensuing year was held during the annual 
business meeting, February 12, 1959. The following members were elected 
to office: 

Leonard J. Goldwater, M. D, , President 
Joseph A. Quigley, M. D. , Vice President 
James H, McDonough, M. D., Treasurer 
Lloyd B. Shone, CAPT MC USN, Secretary 

(OccMedDispDiv, BuMed) 

!(: 5!« Sif sjc :j( Jjs 

The 1959 Industrial Health Conference 

The 1959 Industrial Health Conference will be held in the Hotel Sherman, 
Chicago, 111., 25 April - 1 May 1959. This Conference, jointly sponsored by 
the Industrial Medical Association, Anierican Conference of Governmental 
Industrial Hygienists, American Industrial Hygiene Association, American 
Association of Industrial Dentists, and American Association of Industrial 
Nurses, Inc., is one of the most important educational meetings of the year 
for Naval occupational health personnel. 

As in the past, this Conference will afford unsurpassed opportunity 
for the presentation and discussion of new problems in the field of industrial 
health which have arisen incident to rapid technological progress. Prelimi- 
nary information received from the program planning committee indicates 
that this will prove to be an outstanding Conference, Recognized leaders in 
the field of industrial health will be present representing major private indus- 
tries in the United States and Canada. There will be discussions of mechan- 
isms believed to be most effective in carrying out preventive health measures 
dealing with preplacement and periodic physical examinations, radiation 
hazards, sight conservation, hearing conservation, and industrial toxicology. 
All of these mechanisms are applicable in lowering the over all cost of indus- 
trial production and in maintaining a condition of readiness in the Navy, In 
order to have an adequate and progressive occupational health program in 
the Navy, it is considered highly desirable that Naval and civilian personnel 



Medical News Letter, Vol. 33, No. 6 35 



concerned with the Naval occupational health program attend this Conference. 
Such participation is particularly pertinent as efforts continue to be made to 
integrate more civilian physicians into the Navy's occupational health prog- 
ram and to maintain and improve the present low rates of industrial sickness 
and accidents. 

It is highly recommended that industrial medical officers, industrial 
hygienists, and industrial nurses attend this important Conference. Atten- 
dance of einy one individual will be contingent on the extent to which his 
activity can spare him and the availability of per diem funds. Because the 
Conference is sponsored primarily by nonfederal organizations, orders for 
attendance must be processed in accordance with SecNav Instruction 4651. 8A 
of 4 November 1955. For this reason, applications for orders should be 
processed at an early date. (OccMedDispDiv, BuMed) 

s^e :{c :{c * * ^ 

Occupational Dermatitis 

The vast protective envelope, the skin, which is constantly exposed 
to potential injury from physical, chemical, and biological sources, in most 
circumstances withstands the onslaught without any abnormal effect to the 
skin itself or to other organ systems. However, when the inherent cutan- 
eous defenses are unable to cope with a particular chemical exposure, the 
consequences may include percutaneous absorption and systemic intoxica- 
tion with cutaneous damage, or cutaneous damage without systemic intox- 
ication. In a working environment, the causes of cutaneous insult or damage 
may be: 

1. Physical. Among the physical causes are friction, pressure, elec- 
tricity, heat, cold, and radiation (ultraviolet, infrared, alpha, beta and 
gamma rays, and roentgen radiation). 

2. Chemical. The chemical factors in the environment afford the 
greatest source of injury by primary irritation, by necrotizing action, 
or by allergic sensitization. The chemical incitant may cause an acute 
or a chronic inflammatory reaction. The chemical agent may act spec- 
ifically on the epidermal cells as do keratogenic or carcinogenic agents; 
on pigment formation; or on the pilosebaceous apparatus. 

3. Biological. Among the biologic incitants of cutaneous disease are 
the botanical or plant irritants or sensitizers; bacteria and fungi; the pro- 
tozoa; and the arthropods — infections or infestations which maybe incurred 
in working environments. 

Because the skin is a complex organ system and histologically hetero- 
geneous, a particular occupational incitant may predominantly affect a sin- 
gle tissue component or several components of the skin. The type of patho- 
logic response may vary with the specific stimulus, and the pathologic patterns 
as well as structures may be involved in specific occupational dermatoses. 



36 Medical Ne^ws Letter, Vol. 33, No. 6 

Inflammatory Reactions Contact dermatitis may be of primary irritant 
origin or may involve the delayed type of allergic hypersensitivity. In either 
case, the reactive tissues are chiefly the epidermis and the blood vessels 
and reticuloendothelial cells of the dermis. If the reaction is severe and pro- 
longed, the appendages may be affected as well. Symptoms range in severity 
from mild itching to a severe eczematous dermatitis. 

In allergic contact dermatitis the chemical sensitizer presumably con- 
jugates with skin protein to form the allergen. This new substance, the anti- 
gen, is capable of altering enzyme systems involved in the production of 
cellular protein. The altered cellular protein which is part of, or becomes 
fixed In, the reticuloendothelial cell, constitutes the cell -fixed antibodies 
of hypersensitive persons. 

Epidermal Effects. The epidermis responds quickly to injury and has 
a remarkable restorative capacity. Repeated and prolonged trauma stimula- 
tes n^itosis and results in hyperplasia. Repeated exposure to ultraviolet 
radiation and critical exposures to ionizing radiation and specific cyclic hydro- 
carbons will cause epidermal cells to lose their normal characteristics and 
become neoplastic. 

Pilosebaceous Reactions. Chemical substances of related structure 
appear to single out the pilosebaceous unit and alter sebaceous structure and 
function specifically. Occupational acne is a rather common skin disease 
which may result from exposure to petroleum cutting oils, coal tar fractions, 
and chlorinated hydrocarbons, such as chlorinated naphthalenes, diphenyls, 
diphenyloxides, benzols, and phenols. The chemical stimulus provokes the 
proliferation of follicular epithelium in the sebaceous duct and follicle open- 
ing (infundibulum). These cells become keratinized and plugging of the orifice 
results. This prevents extrusion of sebum and that which is formed is retained. 
The lipid-bearing cells are then replaced by keratinizing cells and the entire 
process eventually results in a sac filled with kertin lamellae and retained 
sebaceous lipid. This is the sequence of events which occur in the evolution 
of the comedo or milia and are identical with the cutaneous events which occur 
in acne vulgaris. 

Unhygienic exposures to cutting oils frequently result in folliculitis. 
This inay be simply the result of follicular or perifollicular irritation by the 
hazardous material, with a secondary inflammatory reaction, complicated 
by acnej and frequently accompanied by bacterial infection. 

Pigmentary Disturbances . Occupational environments may alter pig- 
ment formation in several ways. The inciting factor may lead to either local 
hyperpigmentation or to a reduction of pigmentation. In n:ost instances, the 
pathologic process can be explained on the basis of interference with the 
biocheniical synthesis of melanin and disturbance of one or more of the phys- 
iologic factors regulating melanin formation. 

Chemical materials which enhance the action of ultraviolet light on the 
skin, such as coal tar products, low-boiling petroleum products, essential 



Medical News Letter, Vol. 33, No. 6 37 



oils, and certain dyes, both increase the degree of inflammatory reaction 
to the erythematogenic wave lengths and cause hyperpigmentation at the ex- 
posed site. 

Decrease in pigmentation or pigment loss (leukoderma) may be ac- 
quired in industrial exposures to agerite alba, a rubber antioxidant which is 
the monobenzyl ether of hydroquinone. The explanation of its effect lies in 
the fact that the latter substance is chemically very similar to the quinone 
intermediates evolved in melanin synthesis,, and it probably competes for the 
enzyme tyrosinase with such compounds as dopaquinone. The agerite alba 
may veritably remove the tyrosinase from the reaction and cause a halt in 
new melanin formation. 

The Eccrine Sweat Glands and Ducts . A cutaneous problem of consid- 
erable importance which is provoked by working environments in which the 
environmental temperature is high is prickly heat, or miliaria rubra. The 
pathogenesis of this disease has been ascertained and lesions reproduced in 
experimental subjects. The orifice and upper portion of the sweat duct may, 
in hot humid atmosphere, become occluded by keratin maceration and non- 
specific irritation. This occurs especially in environments in which chem- 
ical agents may cause some damage to the duct orifice, Epidermal injury 
produces abnormal keratinization and hype rkeratotic plugging of the duct 
orifices. When the glands are subsequently stimulated thermally, sweat 
secretion is trapped in the plugged ducts. As pressure increases, the sweat 
breaks through the duct wall and extrava sates into the skin, resulting in ves- 
icle formation and frequently an inflammatory response in which the discom- 
fort from pruritus is severe. In "World War II, among American troops in 
the South Pacific Theater, prickly heat was one of the major causes of inac- 
tivation of combat personnel. 

Collagen and Elastic Tissue Damage . Collagen and elastic tissue 
degeneration and fragnnentation are among the cutaneous effects of prolonged 
exposure to sunlight. Persons who work out of doors, such as farmers, 
ranchers, road construction workers, and sailors are more likely to exhibit 
these tissue changes. Among the chronic effects of overexposure to ionizing 
radiation (radiodermatitis), sclerotic, degeneration collagen fibers are gen- 
erally observed. 

Blood "Vessel Changes. The blood vessels of the skin are notably reac- 
tive to irritants and sensitizers. They are singularly dannaged in prolonged 
low temperature exposures as in pernio, immersion foot, and frostbite. The 
blood vessels constitute an area of fundamental pathologic change resulting 
from prolonged and excessive exposure to ionizing radiation. The vessel 
walls become fibrotic with varying degrees of occlusion leading to ischemic 
changes, including atrophy, necrosis, and ulceration. Chronic radiation 
effects are also manifested by irreversible dilatation of the capillaries and 
telangiectasia. 



3S Medical News Letter, Vol. 33, No. 6 



Sensory Perception Problems . While cutaneous sensation is infor- 
mative as well as protective, potential and actual damage will be reflected 
in cutaneous feeling. Pain, for example, is experienced with injury by 
specific mechanical trauma, radiation, heat, cold, electrical energy, and 
chemical irritants. It is experienced with a severe inflammatory response 
to infection. Itching is apparently a variant of pain subserved by the same 
receptors and nerve fibers and elicited by stimuli which are quantitatively 
lower than the threshold level for pain. It is an ever present symptom of 
many skin diseases, including those of occupational origin. The superficial 
inflammatory reactions provoked by primary irritants and allergic sensiti- 
zers are characterized by pruritus as well as the objective signs of inflam- 
mation. (Suskind, E. R. , Occupational Skin Problems: Journal Occupational 
Medicine, 1:39-45, January 1959) 

3jc 9ic 3{c H^ ;^ :i! 

Hazards of Noise Exposure 

Hearing loss resulting from exposure to noise has long been a prob- 
lem. As early as 1880, there were reports describing the effects of rail- 
road noises upon hearing. Some 10 years later there were descriptions 
of the types of hearing losses occurring among boiler makers. For years 
the expression "boiler maker's ears" has been used to describe the general 
effects of noise exposure on hearing. 

Within the last decade the entire problem of hearing loss resulting 
from noise exposure has become a matter of great concern. The Subconn- 
mittee on Noise, An^erican Academy of Ophthalmology and Otolaryngology, 
under the direction of Dr. Aram Glorig, has carried the burden of continuing 
the investigation of the noise problem. There is no question that, in this 
field, this is an outstanding group. The Subcommittee has numerous reports 
which are available and, in general, will answer questions relating to hear- 
ing loss in industry. 

The question naturally arises: Where are we now? It has been defin- 
itely shown that within one age group those employees who have had a number 
of years of continuous exposure to loud noise will have an average hearing 
loss that is greater than the average hearing loss of similar individuals who 
have not been exposed to noise. The excess hearing loss measured for the 
group exposed to noise cannot be explained by any known cause other than 
exposure to noise. As a result, it is commonly stated that noise exposure 
can cause permanent loss of hearing. 

Noise Exposure . An extremely important concept that must be stressed 
and clearly understood is "noise exposure" which includes not only the type 
of noise but the type and length of exposure. A noise cannot be rated as 
hazardous until the question of noise exposure has been resolved. Long 



Medical News Letter, Vol. 33, No. 6 39 



continuous exposure to relatively moderate noise can produce significant 
hearing losses in persons wlio are especially susceptible to noise exposure. 
However, little is known about the effects of intermittent exposure to either 
steady noises or to impulse noises. This is the area where the pioneering 
work is being done. In general, there is an "engineering understanding" of 
the question of continuous exposure. Intermittent exposure is probably more 
frequently encountered by a larger number of people than is continuous ex- 
posure. 

Susceptibility . Some persons lose a small amount of their hearing 
while others lose a large amount— noise exposure being equal. Therefore, 
if a quick test could be developed that would show which individual wovild be 
the one to lose the largest amount of his hearing for a given exposure, this 
person could be protected or possibly excluded from the noise exposure. 
In a sense, the same problem is facing physicians who try to predict whether 
a particular 20 -year old patient will have, solely as a result of the aging pro- 
cess, more or less than the average loss of hearing by the time he is 60 years 
old. 

The Ear and Hearing Damage. The inner ear is filled with fluid and 
contains the nerve endings that eventually respond to the energy of the sound 
waves. This "response" to sound energy results in the sending of electrical 
impulses from the nerve endings up the eighth nerve to the brain. It is only 
after the brain interprets these electrical signals that "the ear hears, " 

Unfortunately, the damage to the hearing mechanism that results from 
noise exposure occurs in the inner ear. The small nerve endings that send 
electrical impulses to the brain are actually destroyed by the energy from 
the noise exposure. The nature of this destruction is apparently identical 
to the destruction of the nerve endings in the inner ear due to advancing age. 
So far, the medical scientists have been unable to distinguish between the 
hearing losses due to these two causes either before or after death. 

Because the damage is in the inner ear, there is nothing that can be 
done to restore the hearing loss once it has occurred. Therefore, it is 
imperative that such losses be prevented. This should be completely under- 
stood by all who are concerned with the noise problem. 

Measuring Noise and Hearing . The measurement of noise should deter- 
mine the total sound energy present and the frequency distribution of the 
energy. In general, it takes eight octave bands to cover the frequency range 
from approximately 30 to 10,000 cycles per second (c, p. s. ). 

Pure tone audiometry is the technique being used by industry for test- 
ing auditory acuity. To test a subject with a pure tone audiometer, the en- 
vironment must be quiet. The audiometer operator presents a pure tone, 
say 500 c. p. s. (approximately one octave above middle C on the piano), at 
an intensity such that the subject responds. The intensity of the tone is 
lowered until the subject just fails to hear. Threshold is defined as the 
soiind-pressure level of the tone at which the subject hears only 5ft%-o£-the 



40 



Medical News Letter, YoL 33, Ha. 6 



presentations. Such, measurements are carried out at a number of fr.equencies. 
From an industrial point of view, the frequencies now used in the United 
States are 500, 1000,2000, 3000,4000, and 6000 c. p. s. The frequency of 
8000 c. p. s, is sometimes used, and in some Steites, 250 c.p. s. is required. 
The zero or reference loss is taken as the hearing of a statistical group of 
individuals between the ages of 18 and 24 years. Normal hearing, or zero 
loss, implies hearing equal to the average hearing of 20-year old persons. 

Summary. With an adequate hearing conservation prog ram in operation, 
there is essentially no reason why a person should lose a significant amount 
of his hearing. By careful administration of audiometry and by the use of the 
presently known protective devices (ear plugs and muffs), a person's hearing 
may be protected. There is no "single shot" test by which industry can detect 
the susceptible individual whose hearing will be affected by noise exposure. 
However, these persons can be spotted before any significant loss of hearing 
for speech has occurred by using the procedure known as "repeat audiometry. " 
By periodically sampling the hearing of noise exposed persons, change can be 
observed; It is evident that these changes occur first for frequencies above 
2000 c. p. s. ; hence the industrial need for measuring hearing losses at these 
frequencies^ Shifts in hearing losses can thus be detected at high frequencies 
longbefore hearing losses become significant at 2000c. p. s. and below. These per- 
sons can thenbe given further protection or shifted to a work area with les s noise. 

Not enough is known about intermittent exposures to either steady or 
impulse noise. Work still must be done in this area as well as in other areas 
associated with the problem. There is a lot to be learned about temporary 
loss of hearing and how it is related to permanent loss of hearing. Much re- 
mains to be done to fully acquaint industry with the problem and the necessity 
for taking effective steps against noise exposure. (Rudmose, W. , Hazards of 
Noise Exposure: Noise Control, 4: 39-58, September 1958) 



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